Healthcare Provider Details

I. General information

NPI: 1013793546
Provider Name (Legal Business Name): JULIA LYNN FRYE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N DEARBORN ST
CHICAGO IL
60654-3846
US

IV. Provider business mailing address

1534 W FULLERTON AVE APT 3
CHICAGO IL
60614-0319
US

V. Phone/Fax

Practice location:
  • Phone: 312-951-8200
  • Fax:
Mailing address:
  • Phone: 412-860-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009734
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: